Lana I. Boutacoff, PHD, LP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP2623 Issued in MN

Practice address

570 Asbury St
Suite 104
Saint Paul, MN 55104-1849

Phone

(651) 645-7318

Fax

(651) 645-0974

NPI assigned

Dec 21, 2006

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437213469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 ASBURY ST",
            "address_2": "SUITE 104",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551041849",
            "telephone_number": "651-645-7318",
            "fax_number": "651-645-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 ASBURY ST",
            "address_2": "SUITE 104",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551041849",
            "telephone_number": "651-645-7318",
            "fax_number": "651-645-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTACOFF",
        "first_name": "LANA",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "PHD, LP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monique Marie Bourdeaux-Colburn, PSY.D, LP
• Ryan Bourdon, M.D.
• Kaitlin Marie Bourgeois, PHARMD
• Judith Bourland, RNFA
• Allyson Chantelle Bourque, OTR/L
• Ralph S Bovard, MD
• Pamela Bowdry, CDCS PLANNER
• Angela Nicole Bowen, CHW
• Frederick Eugene Bowen Sr.
• Mariya V Bowen

• All providers in Saint Paul, MN
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.